What Factors Identified in Initial Osteoarthritis Management Are Associated With Poor Patient-reported Outcomes After THA?: A Register-based Study

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Fältnamn	Indikatorer	Metadata
000		06943naa a2200373 4500
001		oai:DiVA.org:liu-197025
003		SwePub
008		230818s2023 \| \|\|\|\|\|\|\|\|\|\|\|000 \|\|eng\|
009		oai:prod.swepub.kib.ki.se:153584594
024	7	a https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-1970252 URI
024	7	a https://doi.org/10.1097/CORR.00000000000026812 DOI
024	7	a http://kipublications.ki.se/Default.aspx?queryparsed=id:1535845942 URI
040		a (SwePub)liud (SwePub)ki
041		a engb eng
042		9 SwePub
072	7	a ref2 swepub-contenttype
072	7	a art2 swepub-publicationtype
100	1	a Gustafsson, Kristin,d 1976-u Linköpings universitet,Avdelningen för prevention, rehabilitering och nära vård,Medicinska fakulteten,Department of Physiotherapy, Rehabilitation Centre, Ryhov County Hospital, Jönköping4 aut0 (Swepub:liu)krigu95
245	1 0	a What Factors Identified in Initial Osteoarthritis Management Are Associated With Poor Patient-reported Outcomes After THA? :b A Register-based Study
264	1	b LIPPINCOTT WILLIAMS & WILKINS,c 2023
338		a print2 rdacarrier
500		a Funding: AFA Insurance, Sweden; Futurum - Academy for Health and Care; Region Jonkoping County Sweden; Medical Research Council of Southeast, Sweden
520		a BACKGROUND: Some patients report long-term pain or no improvement in health-related quality of life (HRQoL) or are dissatisfied after THA. However, factors associated with these poorer patient-reported outcomes after surgery are inconsistent and have typically been studied in the late phase of hip osteoarthritis (OA) among patients already eligible for surgery. Earlier identification of risk factors would provide time to address modifiable factors, helping to improve patients' pain, HRQoL, and satisfaction after surgery and reduce the burden on orthopaedic clinics by referring patients who are better prepared for surgery.QUESTIONS/PURPOSES: We analyzed data from patients with hip OA referred to a first-line OA intervention program in primary healthcare at a stage when they had not been referred for THA, and asked: (1) What percentage of patients who proceed to THA report lack of improvement in pain, lack of improvement in HRQoL as measured by the EQ-5D, or are not satisfied with surgery 1 year after THA? (2) What associations exist between baseline factors at referral to this first-line OA intervention program and these poorer patient-reported outcomes 1 year after THA?METHODS: We included 3411 patients with hip OA (mean age 67 ± 9 years, 63% [2160 of 3411] women) who had been referred for first-line OA interventions between 2008 and 2015 and subsequently underwent THA for OA. All patients were initially identified through the Swedish Osteoarthritis Register, which follows and evaluates patients in a standardized national first-line OA intervention program. Then, we identified those who were also registered in the Swedish Arthroplasty Register with a THA during the study period. We included only those with complete patient-reported outcome measures for pain, HRQoL, and satisfaction preoperatively and 1-year postoperatively, representing 78% (3411 of 4368) of patients, who had the same baseline characteristics as nonrespondents. Multiple logistic regression was used to assess the associations between 14 baseline factors and the aforementioned patient-reported outcomes of pain, HRQoL, and satisfaction 1 year after THA, adjusted for all included factors.RESULTS: Five percent (156 of 3411) of the study population lacked improvement in pain, 11% (385 of 3411) reported no improvement in HRQoL, and 10% (339 of 3411) reported they were not satisfied with surgery 1 year after THA. Charnley Class C (multiple-joint OA or another condition that affects the ability to walk) was associated with all outcomes: lack of improvement in pain (OR 1.84 [95% CI 1.24 to 2.71]; p = 0.002), lack of improvement in HRQoL (OR 1.83 [95% CI 1.42 to 2.36]; p < 0.001), and not being satisfied (OR 1.40 [95% CI 1.07 to 1.82]; p = 0.01). Older age was associated with a lack of improvement in pain (OR per year 1.03 [95% CI 1.01 to 1.05]; p = 0.02), lack of improvement in HRQoL (OR per year 1.04 [95% CI 1.03 to 1.06]; p < 0.001), and not being satisfied (OR per year 1.03 [95% CI 1.01 to 1.05]; p < 0.001). Depression was associated with a lack of improvement in pain (OR 1.54 [95% CI 1.00 to 2.35]; p = 0.050) and with not being satisfied (OR 1.50 [95% CI 1.11 to 2.04]; p = 0.01) but not with a lack of improvement in HRQoL (OR 1.04 [95% CI 0.76 to 1.43]; p = 0.79). Having four or more comorbidities was associated with a lack of improvement in HRQoL (OR 2.08 [95% CI 1.39 to 3.10]; p < 0.001) but not with a lack of improvement in pain and not being satisfied.CONCLUSION: The results of this study showed that older age, Charley Class C, and depression in patients with first-line OA interventions were risk factors associated with poorer outcomes regarding pain, HRQoL, and satisfaction after THA. Screening patients with hip OA for depression early in the disease course would provide increased time to optimize treatments and may contribute to better patient-reported pain, HRQoL, and satisfaction after future THA. Further research should focus on identifying the optimal time for surgery in patients with depression, as well as what targeted interventions for depression can improve outcome of surgery in these patients.LEVEL OF EVIDENCE: Level III, therapeutic study.
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Ortopedi0 (SwePub)302112 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Orthopaedics0 (SwePub)302112 hsv//eng
700	1	a Kvist, Joanna,c Professor,d 1967-u Linköpings universitet,Avdelningen för prevention, rehabilitering och nära vård,Medicinska fakulteten,Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm4 aut0 (Swepub:liu)joakv97
700	1	a Eriksson, Marit,d 1971-u Futurum - the Academy for Health and Care, Region Jönköping County4 aut0 (Swepub:liu)marer56
700	1	a Rolfson, Ola,c Professor,d 1973-u Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Orthopaedics, Sahlgrenska University Hospital4 aut0 (Swepub:liu)olaro03
710	2	a Linköpings universitetb Avdelningen för prevention, rehabilitering och nära vård4 org
773	0	t Clinical Orthopaedics and Related Researchd : LIPPINCOTT WILLIAMS & WILKINSg 481:9, s. 1732-1742q 481:9<1732-1742x 0009-921Xx 1528-1132
856	4	u https://liu.diva-portal.org/smash/get/diva2:1789197/FULLTEXT01.pdfx primaryx Raw objecty fulltext:postprint
856	4 8	u https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-197025
856	4 8	u https://doi.org/10.1097/CORR.0000000000002681
856	4 8	u http://kipublications.ki.se/Default.aspx?queryparsed=id:153584594

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